Provider Demographics
NPI:1487136412
Name:ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC
Entity type:Organization
Organization Name:ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0259
Mailing Address - Street 1:15305 DALLAS PKWY STE 1600
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6491
Mailing Address - Country:US
Mailing Address - Phone:972-763-3893
Mailing Address - Fax:972-692-6745
Practice Address - Street 1:8120 TIMBERLAKE WAY STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5413
Practice Address - Country:US
Practice Address - Phone:916-681-2350
Practice Address - Fax:916-681-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical